Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 25MA05469100 | NJ |
Y | 207W00000X | Ophthalmologist | MD034243E | PA |
NPI | 1023028396 |
---|---|
Provider Name | Michele R Piccone |
First Address | Wayne, PA 19087-3029 |
Second Address | Wayne, PA 19087-3029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 01/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0153125 | (05) | NJ |